MEDICARE: REGINA MOFFETT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1235683491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REGINA MOFFETT

Provider Business Mailing Address
First Line	:	905 OAK ST
Second Line	:	APT 44
City	:	HOUSTON
State	:	TX
Zip	:	77018-1568
Country	:	US
Telephone Number	:	832-988-7127
Fax Number	:

Provider Business Practice Location Address
First Line	:	905 OAK ST
Second Line	:	APT 44
City	:	HOUSTON
State	:	TX
Zip	:	77018-1568
Country	:	US
Telephone Number	:	832-988-7127
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2016
Last Update Date	:	08/04/2016

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Directions to “ REGINA MOFFETT ” Practice Location

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